Risky Business - Men and Heart Disease
February is Heart Month. From Valentine’s Day to awareness of heart disease, it’s a heartfelt time. It’s also a great time to remind readers to take charge of their health.
And for men under age 60, the risk of a heart attack is greater than that for women. This is partially due to environmental factors, and that women up until menopause have estrogen in their bodies to act as a protector.
But… are men being screened for their risk? As a child and teen I do not ever once recall my father going to the doctor. He was a three-pack a day smoker, but “real men” don’t just go the doctor for a sniffle or even a general physical!
Dad quit smoking years ago, and is doing great at age 76. But I’ve known several people who have lost dads and brothers who were in their early to mid-50s, or younger, gone much too soon, leaving families behind to wonder… why?
The heart truth: is it reality or myth? The number one way to help prevent heart disease in adult men is to avoid or cut down on cholesterol-laiden foods like red meat, dairy and eggs.
Definitely a myth, says Dr. Gordon Francis, director of the Healthy Heart Program Prevention Clinic at St. Paul’s Hospital, Vancouver. While good nutritional habits and regular exercise are always beneficial for health, the long-held belief that “slothful” behaviour and bad diet alone cause heart attacks is untrue, he says. “A key predictor of heart attacks is inherited risk.”
“If one or more members of your close family, a parent or a sibling, showed signs of coronary heart disease or stroke under age 60 (and either survived or did not), this becomes a huge risk factor to pay attention to,” says Francis. “As far as cholesterol goes, one in 40 people have an inherited lipid disorder that in most cases is not corrected by diet and exercise changes alone, and is frequently a reason for early heart disease in families.”
Francis is a lipid specialist, and at the Healthy Heart Program, patients who have been referred by their physician will be put through a battery of (non-invasive) tests to determine what needs to be done to help prevent a heart attack.
“Our screening process determines your risk based on a number of factors. Is there diabetes in the family, for example, which increases your lifetime risk of getting diabetes by 50 per cent?” Francis says. “Did a close family member develop angina early? All these things are taken into consideration.”
The program works up a complete risk profile for the patient, including LDL and HDL levels and, where indicated, analysis of Lipoprotein (a), a factor that is sometimes the only reason found for early heart disease in families. Blood pressure and blood sugar are checked too, along with diet and exercise assessment, stress levels and other relevant medical history.
And you always hear about how smoking makes skin look prematurely aged, as it restricts the blood vessels. But what’s going on inside is even worse.
“Smoking is the second leading cause of heart attack after abnormalities in cholesterol metabolism,” says Francis. “I can’t stress this enough, that quitting smoking is really important to lower your risk.
“I recently had a patient referred to the clinic whose parents both had heart attacks before age 60, and who had a heart attack himself at age 39 on the basis of inherited high Lipoprotein (a) plus smoking. Men who’ve had a heart attack before 60 frequently have inherited factors that they may not be aware of, as this patient wasn’t,” says Francis.
Some referrals include patients who have had a mild heart attack and their physician wants to know why. At the Healthy Heart Program, the team looks for the reasons, to put people back on track towards a healthy life.
Francis emphasizes healthy diet and regular exercise as important components to heart health. Protective foods include fruit and vegetables, whole grains and other high fibre foods.
Depending on the severity of your lipid levels, and especially with inherited high cholesterol, you may also have additional tests like an ultrasound on your carotid arteries, searching for early plaque. Depending on the overall assessment, you may be prescribed medication like a statin.
The numbers don’t lie. A 2004 study published in The Lancet concluded, by analysing the lives of 15,000 people having their first heart attack (myocardial infarction), that the top three reasons were: 1) poor ratio of lipoproteins (bad over good; often inherited); 2) cigarette smoking; 3) psychosocial stress (measured by standardized questions). Diabetes, high blood pressure and abdominal obesity were also major risk factors.
So, at what age should a man get a full work-up by his physician? “Age 40 is a good time to discuss your lifetime risk,” says Francis. “But if you have early heart disease in the family, get checked out in your 20’s or 30’s,” he says. “If you are adopted and don’t know your blood relatives’ history, earlier than 40 is also better.
“By knowing your numbers, and following a plan to change the behaviors you can and letting medicine or other intervention help those factors you can’t, you can greatly reduce your chance of having a heart attack or stroke.”
For more information on the Healthy Heart Program, go to http://www.heartcentre.ca.
By the numbers (courtesy The Heart and Stroke Foundation):
Heart attack (male & female)
- There are an estimated 70,000 heart attacks each year in Canada. That’s one heart attack every 7 minutes.
- Over 16,000 Canadians die each year as the result of a heart attack. Most of these deaths occur out of hospital.
- The number of heart attack-related hospitalizations has increased steadily over the past decade (1994-95 to 2003-04).
Cardiac arrest (male & female)
- Up to 45,000 cardiac arrests occur each year in Canada. That’s one cardiac arrest every 12 minutes.
- As many as 85% of all cardiac arrests occur in homes and public places.
- Less than 5% of those who have a cardiac arrest outside of a hospital survive.
Free Heart Health Screening Clinics
Have your blood pressure and cholesterol checked by firefighter technicians through the Vancouver Firefighters CPR program at their free monthly screening clinics. Go to http://www.vanffcpr.org/courses/ to register. Next clinics:
- Saturday, Feb. 26, 1-4pm at Firehall Library. (Blood pressure only)
- Sunday, Feb. 27, 9:30am-4pm at #18 Firehall. (Blood pressure and cholesterol)